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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDET DELCARATION
<br />I hcrcby slfrn uid6 p.Elr, of periu.y 1llrl I m cx.npl fiDm llE ConEoclor Lkens L,w fot lh. follo*ing r&en {56.7011.5
<br />Businc$ o.d Pmfeslion tu.): Any Cily or Coonry which rcqliti a lrnn to onsltocl, olld. impmrc, d.rctsn ot EPan y
<br />.'ru.lw. I,ior ro ils issulN, .lio rcquits lb. lPpli:trt for sh Fmit b fih tr si8rcd $a,l.fttrl th.r h. o. 3lE is lisred Ptr$ l
<br />ro rlE pmvisions of dr Conlreols Ltcnsd L3w (C1Bpl6 9. Commftins *irh Se.tio. 7m0 of Divhion I of lhc Ausin.ss and
<br />PmfcssionsCodc)orrh$h.orsh.kcrcnplllErcfronlndlhcl.EsisforlhcalLgctl.x.nption.Anyviolodonofsdriotr0SlSbylny
<br />epplicn.t ror s !c@il su6j€trt applkanr ro a.ivil f.elryotnot mE tbm fivc hlndEd doll&3 (5500).
<br />-1.
<br />&r osNr or$. pmpcny. or my c'ntloyss wilh qlscs &s thcn sb .onp.n{lion. sill do rlE so.t and tlE inl'tle ir ml
<br />i.rc,i.n or olIdcd for slc (S( 7(X4. Busirc$ md P,nl.sio.s Codc: Thc Coir@roa r Lie.k hw &.s nol lrply 16 d ole. ol
<br />rhc l,b!.rry who t{ilds or i,qmB rli&d !d wh6 de3 sh st* himsclf or hcelror rhbu8h hh or ho own cqicr.ci.
<br />prcvidcd rhdl su.h inpmrmnls E ml i,lcd.d o.ofiqtn for str. li howowi llE bl ditrE or atglbtBd h sld vilhii dc rr
<br />ofcon!,lcrbn. dt Owrr Build.r vill &rc dE hnd.f, of pmvi.E tllal lE or dE dil ml hild or inpreE thc potEl, for dE Inqbs of
<br />-l-
<br />asownqntrhc popcir. m.rclusiwlyo relinE wilh licened conrmios t,{nsrMl lh Pmixr (56.7044. aunm:s
<br />ri PiDLssbn Codc: Thc Conrrrru\ Liccnre Llw d@s nor applyro snowrcr offiori.ny eho builds or nnPnv.s lhcreDn,
<br />snd $ho snni.ts for ruch ImFG sirh 0 contreto(s) lian*{ I,utrouir ro rhc c.nlreloas LiIn* l,Q}
<br />I mcxcmd undcr Scclion ,B &PC lbrlhsrco{n
<br />Dat Oso.r
<br />vl)&tr[8li:c0MfENlArloN
<br />DECLAXAII!]!
<br />I hcrcby arfirmundcr lcnollyof rrjrryoN of rhc followin! dcbrarionsl
<br />Ihrv.anl*illartrn rin,C.ni,i.arcolcon{ k, Scll l n\rc ritr *orkcrr coml.nsari(nr' r( fovidcdltrbys..rion:rTuJollhc
<br />Ijllu Cidc. hr rlr Frlinnan(c ol rhc w.rk f{tr shich rht Frnnf ir irsucd
<br />-l
<br />harc and will minrain vor*cB conFnsulk n insurumc, ds rcqoncd by secrion J?c, of th. Ld,or Cod.. ttr lh. Frloirmtrcc o{
<br />thc $olk for stich rhis p.ftit is tscd. My worl6 oml,c.salion insurrn.c ori.r Md lolicy nlnb€r el
<br />l.cnifylh,l in thc p.rfolmncc oflhc wor* foi which $k p.rmn n isrucd, I shlllnor.nll.y any P.son in lny ndft,
<br />$ aslo tEcoft subjcd lo lhc woltc6 snp.r$lior hvs ofcalifomis. a.d !!@ rh ifI should bccom sut'j<l lo rll
<br />*ortc6 coq,.ns ionpmvhionsofScdion 3100ofl6e titor Codc.l shall. fdnhwirh.om0ly *ilh tln* pmlisions.
<br />WAXNINO: Flihrc ro sN mrl6 smpenssliotr co*Bgc h lnlastul. od shall subjc.l u cqttor!.lo djmiial IE Xi6 and
<br />civil fircs ry loor hudt n th.usad d.llm (t100.000). in addilior ro lhe .osl of.onpcf,stion. d.tugcs a provildl a.r rlE
<br />Sccthn 3076 of thc lltD, C.dc, i.lc6.l and lomrt accs,
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<br />APPlor:
<br />ucElsl:[caNr&(raa
<br />DNCIASTIION
<br />I hcichyrfll nundcrpctrrlryofpcrjuryrhlrInmlicci{dund.rpi.visiooiChrPrsI(.rnn'tun.nrB!irhSLrrio.?00t)olDilni t.l
<br />ol rh. Br\irc\\rnd Pn,fcssn)n( (bdc. trnd n'yli(en{ i\ in ,ull ,,tr( ,ixi c,l(
<br />clrlrmuclroli,.ElDldolcEll.lt
<br />I h@by (mrn lndei Fnally of p.rj!ry Inal rh.rc h s consmdbn boding s8cry for thc pcrfomn.c of thc mrt for qhth rhir lHni! ir
<br />issucd (Ss. 1097, Civ.C.),
<br />-l
<br />ccnil, rhar rlr f.d$.I rcgllariotrs rcSading &sbcsros rcd,vd src not .,,plic.bh lo thh Projcd
<br />rll,!c nr Luncd !,rolxnv l,{ ir\tf,.ri{in purExds
<br /> ppli.rnr or gcm SiBn ur.
<br />Pmile nam (Finl):-
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lt/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room i Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.srt/tfl nrW,)
<br />Final Test
<br />Meter Release I
<br />FINAL /O/r</tlt 44{J rJt \
<br />Notes, Remarks, Etc.
<br />Smoke Detectors lnstalled
<br />Ltnd.r'i Nm:
<br />-
<br />ktrd..t ddrc\r
<br />-
<br />an'r-rc,rnr otc:r-,ltt,trttl,'r
<br />Ihcr.$yannur cryr.MlrtoiFrjurr_otrcoilhciolhtrirslc(lurJln,n\:
<br />D. n,lirn'n Pci,nirr \bcrlos Noliti.rri{nr F.ddful R.Suluri('h (Tillc.g). Pan6)
<br />llcquircd lt .rol Norifi.rrh
<br />tt
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